ADOLESCENT

PREGNANCY (Consequences
of Unprotected Sex II)
Level
outline
• List factors that influence pregnancy and childbearing in adolescents
• Describe risks and complications associated with adolescent
pregnancy and childbearing
• Provide care for the pregnant adolescent
• Counsel an adolescent on abstinence and contraceptives
Introduction

• Globally
• 16 million adolescent girls give birth every year, 95% in Low and
middle income countries (LMIC)
• 11% of birth worldwide occur in girls b/w 15-19yrs
• 14% of all unsafe abortion in LMIC occur in girls b/w15-19yrs
• Globally, complications from early pregnancy and childbirth is 2nd
leading cause of death among girls aged 15-19 year
Introduction

• Globally(cont’d)
• Birth rate in girls 15-19years 49/1000 girls
• Account for 23% of the overall burden of disease (DALY) due to
pregnancy and childbirth(among women )
• 65% of obstetric fistula occur in adolescent girls
Introduction

• Ghana
• 12.5% of pregnancies occur among adolescents in 2007 increasing to 14%
in 2017(GMHS 2007, 2017)
• 13% of all births
• 15% of all maternal deaths
• The Adolescent births rates 66/1000 women aged 15-19 (2010)
• Central region recorded about 14,000 teenage pregnancies in 2012, GAR
had 10,960 adolescent pregnancies in 2015
• The percentage of women age 15-19 who have begun childbearing ranges
from 7% in Greater Accra region to 19% in Western region (GMHS2017)
Factors influencing adolescent pregnancy

• Decreasing age at puberty

• Early age at sexual debut
• Early marriage
• Low use of contraceptives(5.2% of modern method in 15-19yrs)
• Lack of knowledge about sex and FP
Factors influencing adolescent pregnancy

• Low education/employment opportunity

• Social norms, e.g. puberty rites etc
• Lack of access to AYFH
• Low socioeconomic status/poverty
• Peer/societal pressure
• Sexual coercion /rape
Risks and Complications Associated with Adolescent Pregnancy
and Childbearing

• Antenatal
• Anaemia
• Poor nutrition
• Malaria in pregnancy
• Hypertensive disorders in pregnancy In labour
Risks and Complications Associated with Adolescent Pregnancy
and Childbearing

• Low birth weight

• Preterm labour and delivery
• Difficult labour and delivery( may have obstructed labour)
• Stillbirth
• Home delivery
Risks & Complications Associated with Adolescent
Pregnancy and Childbearing After delivery(post partum)

• Severe impact of postpartum haemorrhage (PPH) due to underlying anaemia

• Increased neonatal morbidity resulting from prematurity, low birth weight and
infection
• Poor maternal nutrition often carried from the prenatal to postnatal period
• Poor breastfeeding practices
• Genital tract injuries including obstetric fistulae
• Postpartum depression
NB with appropriate management and support, the outcome of adolescent
pregnancy can be favourable.
Why are complication during pregnancy worse in adolescents?

• Biological immaturity
• less empowered to make decisions about matters affecting their
health (as well as other matters)
• Late enrolment for ANC /poor attendance
• Health workers attitude to pregnant adolescent
Why are complication during pregnancy worse in adolescents?

• Likelihood of home delivery due to the ff

-Social and cultural norms may dictate that they deliver at home
- They may be afraid of hospitals;

- They may have heard discouraging stories about mistreatment by

hospital staff (and especially labour room staff)
- They may be unable to bear the hospital charges, or even for the cost
of private transport to get there
Critical aspect of care of pregnant adolescent

• Early diagnosis of pregnancy

• Antenatal care (ANC) this should invlove counselling
• Management of labour and delivery
• Postpartum care including contraception
ANC, Labour & delivery challenges in adolescents

• ANC providers should give assurance and answer questions from the
pregnant adolescent
• Adolescents faces challenges that affect their utilisation of ANC,
labour and delivery services Health Worker should:
• Respect the right of the adolescent to privacy during birth
• Respect the adolescent's choice of companion during labour or birth
ANC, Labour & delivery challenges in
adolescents
• Give the adolescent as much information as she needs or desires
• Observe labour and monitor foetal condition using the partograph to
help detect deviations from normal labour promptly (refer to Safe
Motherhood Protocol)
• Give the adolescent empathic support
• Initiate lactation within the first hour of delivery
Care of pregnant adolescent in school

• Do not criminalise
• Provide social support
• Emphasis should be on continuation of education for as long as
possible
• Return to school after delivery
• Consider foster parenting, adoption and family support
Role of Adolescent health provider

• Respect the adolescent

• Empathize as needed
• Detail sexual / pregnancy history
• Initiate commencement of ANC by the pregnant adolescent
• ANC should be provided by an Adolescent Friendly Service Provider
• Ensure adolescent receive necessary care in pregnancy
Role of Adolescent health provider

Ensure adequate Home/ follow up visit

• Care of the pregnant adolescent Should be tailored towards
• Developmental support
• Emotional support
• Physical support
• Educational support
Developmental need
• Individualized based on needs
• Praise the adolescent when they come for booking visit
• Recognise cultural, racial and religious belief in providing an appropriate care
• Identify the presence or absence of support for the pregnant adolescent
• Physical needs
• Screen for STI/HIV
• Do nutritional assessment
• Look out for signs and symptoms of High risk pregnancy
• Educational need
• Takes more time with adolescents
• Patience is key
• If adolescent has support, education should be provided to the support person too
Role of Adolescent health provider

• ANC
• Post natal
• Preventing adolescent pregnancy
• Sex education before puberty
• Learn negotiating skills
• Strongly encourage abstinence
• Contraception use by the sexually active
• Access to safe abortion services when needed
Role of the adolescent father in ANC,
Delivery and Postnatal Care (PNC)
• Early fatherhood appears to have negative consequences on future
functioning of the adolescent boy to some extent
• An adolescents father should be encouraged to continue their
education /vocation as much as possible
• Encouraged to show commitment to their children
• More frequent contact with their child has positive psychological &
physical effect on the growing child
• Secondary abstinence should be encouraged to prevent re occurrence
where possible
• If still sexually active dual method should be encouraged especially LARC
Abstinence & Adolescent Contraception
Introduction

• High unmet need for contraception in Adolescent (50%)

• Only 6.3% of adolescents (15-19yrs) use a modern method of
contraception (GDHS 2014)
• Male condom ,injectable and implants are the top three
contraceptive method of choice
• Use of highly effective method is low among them
Barrier to contraception

• The unexpected and unplanned nature of sexual activity

• Lack of information and knowledge about contraceptives and where to get them
• Embarrassment and fear of lack of confidentiality
• Fear of medical procedures
• Fear of judgmental attitudes and resistance from providers
• Inability to pay for services and transport
• Displacement – refugees, or political strife
• Fear of violence from partner or parents
• Pressure to have children
Adolescent Contraception

• Goal of adolescent contraception

• prevent pregnancy
• prevent STI/HIV
• Reduce the risky sexual behaviour can be achieved by -abstinence -dual protection
• N.B Counselling & use of highly effective method is key
• Contraceptive counselling in adolescents
• Quality of good counselling for adolescent presenting for contraception 
• Supportive
• Encouraging
• non-judgemental environment
• confidentiality should be ensured
Contraceptive counselling in adolescents

• Counseling should be motivational interviewing approach

• The interview should focus on
- future goals -belief in the adolescents’ capacity to change
- engage the adolescent in the process of adopting health-promoting
behaviors
• Consent of the adolescent after an informed decision is important
Contraceptive counselling in adolescents

The information provided should include the following

• The effectiveness of the method
• Information on protection against STIs including HIV infection
• The common side-effects of the method
• The potential health risks and benefits of the method
• Information on return to fertility after discontinuing use of the
method
• Where the method can be obtained and how much it costs
What method(s) of contraceptives can an adolescent use?

Types of contraceptives
• Non reversible (permanent)
• Reversible
-Long acting reversible contraceptive(LARC)
-Short acting reversible contraceptive(SARC)
• Emergency contraceptive
• N.B Generally, all methods of contraception can be safely used by the
adolescents except the non reversible (permanent) methods
classifications

VERY EFFECTIVE METHOD VERY EFFECTIVE

• LARC methods
EFFECTIVE METHODS
• Pills
• Injectables
• Patch & Rings
MODERATELY EFFECTIVE
• Barrier methods
• Fertility based awareness method(FABM)
LESS EFFECTIVE METHOD
Spermicide LESS EFFECTIVE
Types of contraceptives

• Reversible (short acting)

• Fertility awareness based method(FABM)
• Barrier methods
• Rings & patches
• Injectables
• Oral contraceptive pills
• Reversible (LARC)
-Implants (Jadelle &Implanon)
-IUD/IUS(copper- T & Mirena)
• what are some advantages and disadvantages unique to different
methods of contraception available to adolescents?
Types & importance of contraceptives

• Barrier methods
-condoms (female and male condoms)
-diaphragm, cervical cap
Advantages
• Readily available
• Provides dual protection
• Generally affordable
Disadvantages
• Interferes with coitus
• User skills
• May not be available during adolescent sexual act
Types of contraceptives

• Hormonal pills
• COCP( combined oral contraceptive pills)
• POP( progestin only pills)
Advantages
• Readily available
• Portable
• Can be used along side Condom
• Has non-contraceptive benefits such as mgt of menstrual pain, heavy menses, etc
Disadvantages
• Missed pill common
• Does not protect against STI/HIV infection
Types of contraceptives

• LARC
• They are highly effective
• Can be used by adolescent
• Allow adolescent to achieve goal personal goals
• Return to fertility immediately after removal
Disadvantages
• IUD not recommended for those with multiple sexual partners
Implants may menstrual irregularities
Types of contraceptives

• Fertility awareness based method

• This based on understanding of the menstrual cycle of the individual
over time
• Can be used by those with regular cycles
• Cervical mucus method
• Calendar method
• Basal body temperature
• Symptothermal method
• Two day method
Types of contraceptives

Advantages
• Help to understand menstrual cycle
• No use of products
Disadvantages
• Not recommended in early adolescent
• Does not protect against STIs
Types of contraceptives

Emergency Contraception (EP)

• Recommended when a regular method is not correctly and
consistently used to prevent pregnancy
• Used In method failure
• Useful in case of rape, Incest
• Should not be used as regular contraceptive
• Include: levenogestrol pill, IUD, COCP  In Ghana widely used/
abused in Ghana
• Can cause changes in menstrual cycle
• What are some myth and misconceptions about family planning
methods?
• “adolescents are actors in social change, not simply beneficiaries of
social programmes”
• I am a CHILD not a BRIDE Give me a PEN not a PENIS Ask for my
BOOKS not my BOOBS Pay my SCHOOL FEES not my BRIDE PRICE Give
me EDUCATION not your EJACULATION Say NO to EARLY MARRIAGE
KEEP GIRLS in SCHOOL
• THANK YOU!
• “Education’s purpose is to replace an empty mind with an open one”
~ Malcolm Forbes